Universidade de São Paulo - Campus de Ribeirão Preto - Divisão de Medicina de Emergência do Departamento de Clínica Médica, Ribeirão Preto, SP - Brazil.
Arq Bras Cardiol. 2020 Jan;114(1):35-44. doi: 10.36660/abc.20180309.
A significant reduction in the morbidity and mortality related to ST-segment elevation myocardial infarction (STEMI) has been achieved with the development of reperfusion therapies. Early diagnosis and correct initial management are important to ensure this benefit. In Brazil, recent graduates in medicine are responsible for a large part of the initial care provided for these patients.
To assess the clinical competence in the diagnosis and initial treatment of STEMI by newly graduated physicians applying for a medical residency program.
We assessed the performance of 771 applicants for the direct entry selection process of the FMRP-USP Clinical Hospital Medicine Residency Program, performed in a simulated setting of STEMI, with professional actors and medical evaluators, using a standardized checklist following the recommendations of the Brazilian Guidelines for the management of this disease.
The general performance score presented a median of 7 and an interquartile range of 5.5-8.0. In relation to the items assessed: 83% required ECG monitoring, 57% requested the insertion of a peripheral venous access catheter, 95% administered acetylsalicylic acid, 80% administered a second antiplatelet agent (p2y12 inhibitor), 66% administered nitrate, 71% administered morphine, 69% recognized the diagnosis of STEMI, 71% assessed the pain duration, 63% recognized the need for immediate transfer, 34% showed adequate communication skills and only 25% insisted on the transfer even in case of non-availability of beds.
The initial diagnosis and management of STEMI need to be improved in medical undergraduate courses and inserted into the reality of the hierarchical network structure of the Brazilian Unified Health System (SUS).
随着再灌注治疗的发展，ST 段抬高型心肌梗死（STEMI）相关的发病率和死亡率显著降低。早期诊断和正确的初始治疗对于确保这一获益至关重要。在巴西，医学专业的应届毕业生负责为这些患者提供大部分初始治疗。
评估申请医学住院医师项目的应届毕业生在 STEMI 的诊断和初始治疗方面的临床能力。
我们评估了 FMRP-USP 临床医院医学住院医师项目直接入学选拔过程中的 771 名申请人的表现，在 STEMI 的模拟环境中进行，使用专业演员和医学评估员，按照巴西该疾病管理指南的建议使用标准化检查表。
总体表现评分为中位数 7 分，四分位距为 5.5-8.0。在评估的项目中：83%需要进行心电图监测，57%要求插入外周静脉通路导管，95%给予阿司匹林，80%给予第二种抗血小板药物（p2y12 抑制剂），66%给予硝酸盐，71%给予吗啡，69%识别出 STEMI 诊断，71%评估疼痛持续时间，63%认识到需要立即转院，34%显示出适当的沟通技巧，只有 25%坚持转院，即使没有床位。
医学本科课程需要改进 STEMI 的初始诊断和管理，并将其纳入巴西统一卫生系统（SUS）的层级网络结构的实际情况中。
